Nursing realignment law

from Wikipedia, the free encyclopedia
Basic data
Title: Law on the realignment of long-term care insurance
Short title: Nursing realignment law
Abbreviation: PNG
Type: Federal law
Scope: Germany
Legal matter: Social security law
Issued on: October 23, 2012
Entry into force on: October 30, 2012
Weblink: Text of the PNG
Please note the note on the applicable legal version.

The law on the realignment of long-term care insurance (Pflege-Neuausrichtungs-Gesetz - PNG) came into force on October 30, 2012. It was decided by the German Bundestag on June 29, 2012 with the votes of the Black-Yellow Coalition (CDU / CSU / FDP). The most important provisions of the law were available on January 1 and 4, 2013, respectively.

It supplements the compulsory long-term care insurance introduced in 1995 with the Care Services Supplementary Act of 2002 and was expanded from 2015 by the long-term care strengthening acts .

Goal setting

The law should u. a. New or improved services for dementia patients and their relatives, the promotion of new forms of living (so-called care WGs - care residential communities), as well as state subsidies for private supplementary care insurance (known as “Pflege- Bahr ” - a subsidized private provision based on the Riester type) Pension ). At the same time, the contribution rate to the statutory long-term care insurance was raised from 1.95 to 2.05 percent on January 1, 2013, and to 2.3 percent for childless people in order to finance the benefits especially for people with dementia.

It was expected that this increase in the contribution rate of the statutory long-term care insurance would bring in additional income of around 1.1 billion euros annually from 2013 to 2015. The BMG hoped with raised contribution rate not only the advanced services for people with dementia, but to finance by the year 2018 all the benefits of statutory care insurance.

Legislative process

After various delays, the federal cabinet approved the key points for the long-awaited long-term care reform in mid-November 2011. The federal cabinet then launched the draft law on March 28, 2012. On April 26, 2012, the Bundestag debated the first reading of the draft law on the realignment of long-term care insurance (Nursing Realignment Act - PNG) and referred the draft to the committees for further discussion. After the second and third reading on June 29, 2012, the German Bundestag passed the law on the realignment of long-term care insurance (Nursing Reorientation Act - PNG) with the votes of the Black-Yellow Coalition (CDU / CSU + FDP). In a roll-call vote, 324 of 591 MPs (votes cast) voted for the law, 267 against. There were no abstentions.

The SPD , the Left and Bündnis 90 / Die Grünen had counter-motions that went far beyond this bill, but none of them found a majority.

At its meeting on September 21, 2012, the Federal Council - contrary to the recommendation of its health committee - decided not to raise an objection or to appeal to the mediation committee . The law came into force on October 30, 2012, but the most important regulations only on January 1 and 4, 2013.

Content or effects of the law

Higher benefits for people with dementia

The core of the Care Reorientation Act (PNG) are the improved services for people with dementia in home and outpatient care. In Germany around 1.4 million people are currently suffering from dementia. It is expected that this number will increase to around 2.1 million by 2030. In response to these figures, people in need of demented care who are cared for at home / outpatient received higher care benefits in kind and care allowance from the statutory long-term care insurance from January 1, 2013 . The Ministry wanted these measures in anticipation of a new care concept to be understood that dementia care who were not yet sufficiently taken into account, including with.

Care level 0

Persons insured in long-term care insurance with limited “everyday skills” (e.g. people with dementia ) who, according to the previous assessment process, are not yet a care case and have not been assigned to care levels I, II or III (care level 0) and until the law comes into force who received only a care allowance of 100 euros (basic need) or a maximum of 200 euros (increased need) per month, were now entitled to 225 euros per month for care benefits in kind when care was taken over by a care service or 120 euros care allowance for caregivers since January 1, 2013 Relatives.

Care level I and II

People in need of care with significantly limited everyday skills in care level I now received 665 euros for care benefits in kind (previously: 450 euros) or 305 euros care allowance (previously: 235 euros).

In care level II, it was 1,250 euros for care benefits in kind (previously: 1,100 euros) or 525 euros for care allowance (previously: 440 euros). Care benefits in kind and care allowance can also be combined .

Care level III

In care level III, however, the benefits remained unchanged at the previous level. The BMG estimated that around 500,000 people in need of care with dementia will benefit from the improved services. Of these 500,000, around 40,000 people would have a care need below care level I.

Promotion of residential groups - "care shared apartments"

With the PNG, residential groups of people in need of care were supported on an outpatient basis. These were shared apartments of at least three people in need of care, with the purpose of jointly organized nursing care. People in need of care who lived in such assisted living groups received an allowance of 200 euros per month according to the PNG (today: 214 per month). The prerequisite is, among other things, that a nurse is active in the living group who takes on organizational, administrative and nursing tasks. If such a group is founded after the Nursing Reorientation Act has come into force, funding of 2,500 euros per person is provided. The total amount for a shared apartment is limited to 10,000 euros. A further 10 million euros were available from 2015 to 2018 for the scientifically supported further development of new forms of living (according to Section 45f SGB XI). Funding should be given to concepts that offer resident-oriented individual care - outside of fully inpatient facilities.

Promotion of private supplementary insurance - "Pflege-Bahr"

The FDP pushed through the entry into private long-term care insurance within the black-yellow coalition. A voluntary supplementary insurance - also known as "Pflege-Bahr" - is intended to help citizens, if necessary, to privately supplement the payments from their existing general care insurance. At a coalition summit, they agreed on the financial support of private supplementary long-term care insurance.

In return, the FDP agreed to the care allowance demanded by the CSU . The FDP had tied its approval to an agreement on private long-term care provision. In their coalition agreement, the CDU / CSU and FDP agreed to add a second privately financed pillar to the statutory long-term care insurance. A private supplementary long-term care insurance should - originally - be compulsory. The details of the private supplementary long-term care insurance were determined by ordinance at the end of November 2012 (long-term care allowance implementation regulation). This regulation came into force on January 4, 2013.

From January 4, 2013, anyone who takes out additional private insurance in addition to statutory long-term care insurance will receive a monthly allowance of 5 euros (60 euros per year) from the state. This grant is paid regardless of the premium or income of the individual. The supplementary long-term care insurance must provide benefits for all care levels - for care level III at least 600 euros per month. Anyone who takes out such additional insurance must pay in at least as much as they get from the state. In other words: five euros or more per month.

In contrast to the Riester pension, there are no tax advantages for private provision. Taking out such an insurance, the so-called “Pflege-Bahr”, is voluntary. Such supplementary insurance should be non-discriminatory. In other words: the insurers should not be allowed to refuse applicants and also not require a health examination in order to assess how great the risk is that an applicant will later become a need for care.

However, the insurers can set the premiums and the level of benefits based on their own calculations. No allowance should be given to people under the age of 18 and people who have already received certain care benefits before taking out a care riest.

Despite the criticism that the benefits of the Pflege-Bahrs are too low, the introduction of a subsidized long-term care insurance can be described as a success by the government. In 2013, with over 350,000 new contracts, more than twice as many people opted for the Pflege-Bahr as for an unsubsidized policy.

Outreach dental care in nursing homes

Outreach dental care in facilities and in the home environment has already been improved with the Statutory Health Insurance Care Structure Act. Dentists receive additional remuneration for the outreach care of people in need of care and people with disabilities who cannot, or only with great effort, visit a dental practice due to their need for care or disability. With the law on the realignment of long-term care insurance, this remuneration was extended in Article 3 for reasons of equal treatment to the now visiting care of immobile persons with considerably limited everyday skills in Section 87 (2j) SGB V. According to Section 119b (1) SGB ​​V, contract dentists have been able to conclude cooperation agreements with inpatient care facilities individually or jointly since April 1, 2014 . In order to create incentives for dentists in the field of contract dental care, to agree cooperation contracts and to carry out home visits to nursing home residents, the evaluation committee has provided additional remuneration for dental services in the evaluation standard of dental services: visits / outreach care , which are provided within the framework of a cooperation agreement.

Information obligation

In general, the question of medical, specialist and dental care for residents is an important criterion when deciding on a care facility. Therefore, as of January 1, 2014, nursing homes must provide information on how they organize medical care, including supplying the residents with medicines.

financing

The government at that time estimated additional costs for long-term care insurance of 1.1 billion euros for the new services. In order to be able to finance this, the contribution rate to the statutory long-term care insurance was increased on January 1, 2013 from 1.95 percent of the gross wage to 2.05 percent - financed equally by employers and employees. For childless, the contribution was increased to 2.3 percent.

criticism

The opposition in the Bundestag, trade unions, health insurances, social associations and employers criticized the new law as a reform, deception, scandal, indictment of poverty and zero number that does not solve the actual problems.

In the Nursing Reorientation Act - PNG, it was particularly criticized that no new definition of the need for long-term care was introduced and implemented.

outlook

In the coalition agreement signed by the grand coalition (CDU / CSU + SPD) on December 16, 2013 , it was stated on p. 59f. recorded the following:

“We want to better recognize the need for care in order to improve the situation of those in need of care, of relatives and people who work in care. To this end, we want to introduce the new definition of the need for long-term care on the basis of the recommendations of the Expert Advisory Council as soon as possible in this legislative period. In particular, people with dementia should receive better and more tailored services. Those who receive benefits today will not be worse off with the introduction. [...] Until the new concept of long-term care has been implemented, we will, above all, rapidly expand the existing care services and extend them to all those in need of care. "

In his inaugural address to the German Bundestag on January 30, 2014, the new Federal Minister of Health Hermann Gröhe stated :

“In a first step, we want to tackle the dynamization of services and, by making the services more flexible and with better staffing, help ensure that the individual situation of a person in need of care can be better taken into account. Good care takes more time. We want to implement this justified requirement of the nursing staff. To this end, we will increase the contribution rates by 0.2 percentage points as of January 1, 2015, thus increasing the benefit volume by 2.4 billion euros. A further contribution increase of 0.1 percentage points is to be used for a long-term care provision fund in order to mitigate an increase in contributions when the baby boomers reach the long-term care age . In a second step, we want to introduce the necessary implementation of the new concept of long-term care with a premium increase of another 0.2 percentage points. Thereafter, 5 billion euros more will be available for long-term care insurance benefits each year. This means an increase in service volume by 20 percent. That is a real show of strength. "

The announced “first step” - the dynamization of long-term care insurance benefits had already been announced in the coalition agreement of November 11, 2005 (Grand Coalition CDU / CSU + SPD). Under point 8.2. ( "Improvements on the performance side" ) one explained:

“The long-term care insurance benefits have remained unchanged since 1995 and are therefore subject to a gradual decline in value. Increasingly, people in need of care must therefore be supported by social assistance. The care services should therefore be made more dynamic. "

However, it was not until the middle of 2008 that the so-called Long-Term Care Development Act was passed (a) it was decided to make step-by-step adjustments up to 2012 and (b) regular performance dynamizations were legally anchored in Section 30 of Book XI of the Social Code. However, this dynamic performance should first be checked in 2014 and only take place from 2015 (and from then on every three years):

“Every three years, for the first time in 2014, the federal government reviews the necessity and amount of an adjustment of the benefits of the long-term care insurance. The cumulative price development in the last three complete calendar years serves as an orientation value for the need for adjustment; It must be ensured that the increase in the benefit amounts is not higher than the gross wage development over the same period. The general economic conditions can also be taken into account in the examination. "

For those affected - those in need of care - the announced dynamization (from 2015) will hardly produce any effective improvements. Because in the coalition agreement of 2013 it was by no means intended to compensate for the progressive loss of value since 1995 (catching up) and to fully cover the benefits of long-term care insurance with the (actual) care costs. It is only intended to increase the then (2015) applicable lump-sum benefits for long-term care insurance by the depreciation of the last three years. The care costs would therefore still not be fully covered, but only partially covered by the insurance, the co-payments that the person in need of care (or their relatives or the social welfare office) would have to pay, would continue to exist or would also increase.

By two nursing strengthening laws , the Federal Ministry of Health wants to implement in this election period significant improvements in nursing care.

See also

Web links

literature

  • Sonja Reimer: “Overview of the changes brought about by the Care Reorientation Act.” In: Die Sozialgerichtsbarkeit 2013, pp. 193–199.

Individual evidence

  1. ^ Draft of a law for the realignment of long-term care insurance (Care Reorientation Act - PNG - BT-DrS 17/9369 / April 23, 2012)
  2. ↑ German Bundestag - 188th session - June 29, 2012 - BT- plenary minutes 17/188 - agenda item 44 / Second and third discussion of the draft law introduced by the federal government for the realignment of long-term care insurance (Nursing Reorientation Act - PNG)
  3. ↑ Parliament No. 22-24 / 29. May 2012: "We are missing a real realignment" ( Memento of the original from February 2, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bundestag.de
  4. ↑ faz.net June 9, 2012: Subsidy for long-term care insurance. What does the Pflege-Bahr bring? - here: Graphic: Little money in the till. Financial development of the statutory long-term care insurance 1995–2010
  5. ↑ BMG - press release of September 3, 2013: Financing of care through the Care Reorientation Act (PNG)
  6. ↑ Spiegel-Online December 16, 2011: Setback for Minister Bahr: Consultant refuses to chair the care advisory board
  7. ^ Draft of a law for the realignment of long-term care insurance (Care Reorientation Act - PNG - BT-DrS 17/9369 / April 23, 2012)
  8. ↑ German Bundestag - 175th session - April 26, 2012 - BT plenary minutes 17/175 - Agenda item 3 / First discussion of the draft law introduced by the Federal Government for the realignment of long-term care insurance (Nursing Reorientation Act - PNG) (Printed matter 17 / 9369)
  9. ^ Draft of a law for the realignment of long-term care insurance (Care Reorientation Act - PNG - BT-DrS 17/9369 / April 23, 2012)
  10. ↑ Opinion of the Bundesrat and counter-statement of the Federal Government - BT-DRS 17/9669 - May 16, 2012
  11. ↑ German Bundestag - 188th session - June 29, 2012 - BT- plenary minutes 17/188 - agenda item 44 / Second and third discussion of the draft law introduced by the federal government for the realignment of long-term care insurance (Nursing Reorientation Act - PNG)
  12. ^ German Bundestag - 188th session - June 29, 2012 - BT plenary minutes 17/188 - result of roll-call vote, p. 22642 ff.
  13. ↑ manager-magazin June 29, 2012: Higher contributions. Bundestag resolves care reform
  14. ↑ Application by MPs Hilde Mattheis, Karl Lauterbach ... and the SPD parliamentary group: Introduce a new definition of the need for long-term care - Use opportunities to make necessary changes - Bt-DrS 17/2480
  15. ↑ Application by MPs Kathrin Senger-Schäfer, Diana Golze ... and the DIE LINKE parliamentary group: Really realigning care - enabling a life in dignity - BT-DrS 17/9393
  16. ↑ Application by Members Elisabeth Scharfenberg, Birgitt Bender ... and the Bündnis 90 / Die Grünen parliamentary group: For a fundamental reform of long-term care insurance - user-oriented, solidarity, future-proof - BT-DrS 17/9566
  17. ↑ s. Speeches put on record on this German Bundestag - 178th meeting - May 10, 2012 - BT plenary minutes 17/188 - Agenda item 16 - The speeches were put on record. - s. Annex 10, p. 21311 ff
  18. ↑ German Bundestag - 188th session - June 29, 2012 - BT plenary minutes 17/188 - Agenda item 44 / Second and third deliberations on the draft law on the realignment of long-term care insurance introduced by the Federal Government (Nursing Reorientation Act - PNG); here: p. 22640 / the different voting behavior in the individual counter-motions
  19. ↑ German Federal Council - 900th meeting - September 21, 2012 - BR- plenary minutes 900, agenda item 3: pp. 378A - 380C ( memento of the original of February 2, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked . Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bundesrat.de
  20. ↑ s. also German Federal Council - 896th meeting - May 11, 2012 - BR- plenary minutes 896, agenda item 28: pp. 224C - 224D - here: Annexes 16 + 17 (pp. 245–247) statements by State Minister Margit Conrad (SPD / Rhineland- Pfalz) and Minister Bernd Busemann (CDU / Lower Saxony) ( Memento of the original from February 2, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bundesrat.de
  21. ↑ Federal Law Gazette (BGBl.) Year 2012, Part I, No. 51, p. 2246: Law on the realignment of long-term care insurance (Nursing Reorientation Act - PNG) of October 23, 2012
  22. ^ BMG - press release of November 28, 2013: Dementia. The Nursing Reorientation Act provides more benefits for people with dementia
  23. ↑ BMG (brochure): Advice on care, 11th edition / as of June 2013, p. 59ff ( Memento of the original from February 25, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bundesgesundheitsministerium.de
  24. ↑ BMG (brochure): The Care Reorientation Act (status after the 3rd reading in the Bundestag), 3rd updated edition July 2012, p. 10/11 (graphic) ( Memento of the original from November 1, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bundesgesundheitsministerium.de
  25. ↑ BMG (Brochure): The Care Reorientation Act (status after the 3rd reading in the Bundestag), 3rd updated edition July 2012, p. 6 ( Memento of the original from November 1, 2013 in the Internet Archive ) Info: The archive link was used automatically and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bundesgesundheitsministerium.de
  26. ↑ s. also GROWTH. EDUCATION. COHESION. Coalition agreement between CDU, CSU and FDP, 17th legislative period, p. 92ff (9.2. Care. Further development of long-term care insurance) ( Memento of the original from September 18, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bmi.bund.de
  27. ↑ BMG (Brochure): The Care Reorientation Act (Status after the 3rd reading in the Bundestag), 3rd updated edition July 2012, p. 10 ( Memento of the original from November 1, 2013 in the Internet Archive ) Info: The archive link was used automatically and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bundesgesundheitsministerium.de
  28. ↑ Further development of new forms of living according to § 45f SGB XI. In: gkv-spitzenverband.de. Retrieved February 21, 2020 .
  29. ↑ s. also GROWTH. EDUCATION. COHESION. Coalition agreement between CDU, CSU and FDP, 17th legislative period, p. 92ff (9.2. Care. Further development of long-term care insurance) ( Memento of the original from September 18, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bmi.bund.de
  30. ↑ Text of the long-term care allowance implementation regulation
  31. ↑ BMG - press release of November 28, 2012: Private long-term care provision - Cabinet adopts implementing regulation
  32. ↑ Conditions for taking out subsidized long-term care insurance , last accessed on May 12, 2014.
  33. ↑ State-subsidized tariffs are of little use , last accessed on May 12, 2014.
  34. ^ Popular care Bahr ( Memento from May 12, 2014 in the Internet Archive ), last accessed on May 12, 2014.
  35. ↑ German Bundestag DrS 17/10166 (June 27, 2012): Report of the budget committee (8th committee) according to § 96 of the rules of procedure on the draft law of the federal government - printed matters 17/9369, 17/9669, 17/10157 - draft of a law on Realignment of long-term care insurance (Long-term Care Reorientation Act - PNG)
  36. ↑ taz June 29, 2012: Bundestag adopts reform. Maintenance becomes a bit more expensive
  37. ↑ taz June 29, 2012: The care sector and costs are the ethical litmus test for society. The new body classes
  38. ↑ Spiegel-Online June 29, 2012: Violent attacks by the opposition. Bundestag resolves care reform
  39. ↑ Shaping Germany's future. Coalition agreement between CDU, CSU and SPD / December 16, 2013, p. 83
  40. ↑ German Bundestag - plenary minutes 18/11 - 30 January 2014, p. 749ff.
  41. ↑ Together for Germany. With courage and humanity. Coalition agreement between CDU / CSU and SPD, p. 108
  42. ↑ Barmer GEK: Care Report 2009, p. 35ff. (In particular Table 3 / overview of the planned performance adjustments) ( Memento of the original from February 22, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / presse.barmer-gek.de
  43. ^ SGB ​​XI § 30 : Dynamization
  44. ↑ German Bundestag - 16th electoral term - printed matter 16/7439 - 7 December 2007 - draft law of the federal government: draft of a law for the structural further development of long-term care insurance (long-term care development law) - s. here § 30 SGB XI: Dynamization
  45. ^ Federal Ministry of Health: Long-term care insurance benefits
  46. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, pp. 51–53 ( Memento from December 24, 2013 in the Internet Archive )
  47. ↑ s. to the structural design of a law - German Bundestag - 16th electoral term - Printed Matter 16/8525 - 12 March 2008 - resolution recommendation and report of the Committee on Health (14th Committee) to the bill of the Federal Government - Printed matter 16/7439, 16/7486 Further development of long-term care insurance (Long-term Care Further Development Act) and amendments, p. 4: D: Financial impact